By Mark Chidley, LMHC, CAP
Certified Practitioner, Rapid Resolution Therapy
All therapists have the common experience of sitting in a
first-session intake with a distraught client where you learn that they have
tried therapy three, four, five, half a dozen or more times before for the same
issue. Some might ask themselves, "What about them has made it so hard for
others to help them?" That is the wrong way to look at them. The reason this
client has not found relief is typically because the prior therapists
didn't know how to fix what was wrong. You see, clients are in pain and their
pain makes them very persistent in their search for relief. They will tolerate
being viewed as a walking pathology but will not tell their therapists about
the toxic effect that it is having or the fact that the therapy really isn't
working for them. They are on our turf and they know it, and even the boldest of
people will keep it to themselves. They will simply cancel their appointment
one day and stop coming in.
So what is going wrong? I didn't really understand it until
I studied and became certified in Rapid Resolution Therapy. RRT clinicians are
taught to pay very close attention to the connection that is
forming from the very first moments. We are taught to speak with our intended
effect always in mind. If we can't help the client, then we make it clear to
them that it's due to our lack of skill and not some defect in them. We don't
put it on them or make it about them. But happily and thankfully most of the time
we can help and usually within the first few sessions.
My purpose here is not to explain the technical side of how
this is done but rather to show what's usually going on and contrast it to what
I consider a qualitatively better experience. Not long ago, I watched a tape of
a therapist of another stripe working with an Iraqi vet with severe PTSD. She
had been with him for a whole year of sessions and yet he was still flooding,
having nightmares, unable to work, drinking episodically to manage intense distress,
mired in deep shame about his condition and the effect it was having on his
marriage. She was trying her best in a conjoint session to improve the
connection between the vet and his frustrated, scared spouse. The discussion
that ensued among mental health professionals in the room assumed this man was
unfixable and that he would have to live with his condition forever. That at
best, a stronger relationship with his partner could possibly buffer the
devastating effects of PTSD and counseling would aim at helping them manage it
together. As beneficial as a good marriage might be, I saw right there, with
the technologies on hand to address some of the more difficult conditions, many
of us therapists have lost hope in our own craft. They continue to meet with
clients, as this therapist had, under the cloud of knowing they have little to
offer for the problem at hand and think they are doing well with at least
offering "support." But that crucial shift would never be directly disclosed.
I stopped to consider what a curious thing this is that
might only be happening in our field. If a dentist couldn't fix a tooth or a
mechanic couldn't repair a car system, they would say so in the work-up phase and
either refer to a more qualified colleague or break the bad news without delay.
There is a basic dishonesty going on in mental health. I can't say for sure why
it occurs. My guess is it occurs unintentionally because of a confluence of
complex causes that exist in our field, among them shame at not having an answer,
the need to be needed, and sharp ideological competition. I couldn't help but
wonder what effect meeting under this cloud would have on both therapist and
client through time.
I imagine it like this:
This vet would continue to come in for his weekly supportive
meeting with his individual therapist. He would be looked upon as an especially
problematic (read hopeless) case and everyone right out to the receptionist at
the front desk would view him that way. He would be recommended to go on
regular doses of prescribed medication and warned he must stay on his regime.
He would pay his copays and assemble and submit the documentation necessary to
stay on disability, which would now be incentivized and protected because itʼs
his only means of income. He might be funneled into a support group with other
vets who've come to see themselves as broken and be encouraged to sit with them
once a week and talk about it--the misery of living with horrific symptoms and
just struggling to stay alive. This is the current state of the art, with few
exceptions. Iʼm thinking if Iʼm that vet Iʼd go anywhere, to the ends of the
earth if necessary to escape this fate. I would avoid like the plague anyone
who would see me that way or recommend that dance card as my primary treatment
plan. I would want to start fresh with someone who believed I could get well.
Iʼve been trained in a way that is more effective than most
and looks at clients as people who can get well. Iʼm aware as I write this we
in the RRT community havenʼt done a good job of getting the word out. We have
to do better. We have to let those with broadcast abilities know that weʼve
left behind our traditional training and the dead ends it leads to, and that we
do therapy in a much different way and from a much different orientation.
We don't just care,
we actually repair.
Mark A. Chidley, LMHC, CAP, a fully licensed mental health
counselor and certified addictions professional, offers counseling services at
his office Kelly San Carlos Executive Center in Fort Myers, Florida.He has been in private practice
since 1997. He holds certifications in Rapid Trauma Resolution (2010), Imago
Relationship therapy (2001), and now specializes in the treatment of couples as
well as individual trauma recovery and anxiety issues. He brings rich experience
from a combined 26 years of hospital work and mental health counseling.
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